Appendix 3: The Health Foundation’s work in building improvement capability within general practice

Over the past decade, almost one in 10 general practices in England, Scotland and Wales have taken part in an improvement programme funded by the Health Foundation. Our investment in general practice began in 2007 with the Engaging with quality in primary care programme, which involved 350 practices and provided useful learning about how to build improvement capability and capacity in primary care. In subsequent years we have supported large-scale projects that have sought to improve safety in general practice in Scotland and to embed shared decision-making in practices.

Currently, we are supporting projects based in general practice through a range of improvement programmes, including our recent programme Increasing continuity of care in general practice, which provides large-scale GP practices and federations with grants of up to £250,000 over 12–24 months to carry out improvement work to increase continuity in their practices.

Two of the projects we have supported recently are described below:

Enabling Quality Improvement In Practice (EQUIP) – Tower Hamlets CCG

EQUIP aims to help GP practices in Tower Hamlets to work smarter using existing resources, supported by live operational data and coaching to make effective changes.

The project, which received support from the Health Foundation’s Innovating for Improvement programme, equips practices with real-time data and the skills to use that data to drive improvements. QI capabilities are also embedded in every practice through weekly sessions with a QI coach and training for practice staff. Team development interventions  are also included to ensure the teams are able to communicate and make decisions effectively in order to deliver the changes.

EQUIP involves 31 GP practices in Tower Hamlets and the borough’s out-of-hours service. Through EQUIP, practices have addressed a range of pressing access issues, such as how to increase their appointment capacity in response to high demand or improve the reliability of their phone service. Other practices have focused, among other things, on improving their document-handling systems and the way in which they manage new patients.

Clinical Effectiveness Southwark – Southwark CCG 

For over 20 years the Clinical Effectiveness Group (CEG) in east London has played a major role in improving health care delivery in three of the UK’s most deprived boroughs. The group helped the area become the UK’s highest performer over a wide range of GP quality indicators. This project, which is being supported through the Health Foundation’s Scaling Up programme, is undertaking a series of clinical improvement initiatives in areas such as atrial fibrillation, diabetes, hypertension and heart failure. It aims to spread the approach developed by the CEG in east London across 45 GP practices in Southwark and is underpinned by three principles:  

  • ‘Belief’ (guidelines, education and awareness-raising among stakeholders and clinical leaders).  
  • ‘Act’ (using trusted templates to support evidence-based practice, regular feedback through analytics and making the use of real-time data core to the daily work of clinicians).  
  • ‘Motivation’ (cross-practice learning and aligning incentives to clinical effectiveness areas). 

The Health Foundation has also supported the RCGP to help it develop a range of learning resources – such as a set of ‘how-to bite-sized guides’ – designed to build practices’ awareness and understanding of QI. We have also been working in partnership with the RCGP and NICE to develop a set of QI modules for inclusion in the QOF in England.

Elsewhere, Q, which is an initiative connecting people, who have improvement expertise, across the UK, hosts a special interest group focused on improvement in primary care. Q is led by the Health Foundation and supported and co-funded by NHS Improvement. As of December 2019, the community has over 3,500 members in total, sharing ideas, enhancing skills and collaborating to make health and care better.

The Health Foundation has also established the Healthcare Improvement Studies (THIS) Institute at Cambridge University to strengthen the evidence-base for improving quality and safety in healthcare. THIS offers fellowships to build academic capacity for the study of improvement, and conducts research, including work on primary care. One research project will assess what sort of avoidable disruptions GPs encounter, and how these operational failures can be addressed.

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